Skilled Teaching for Dementia Patients

NHIC, Corp. has just released a medical policy article that addresses a specific category of skilled nursing care currently available to Medicare home health beneficiaries who have dementia with behavioral disturbances; A51856 Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances.  The category of skilled nursing is called “teaching and training activities”, defined in the CMS Manual System. The Medicare beneficiaries with dementia and behavioral disturbances could receive a patient-centered care plan directed at teaching the family or caregiver how to manage the behavioral disturbances.

Refer to Article A51856 for sample case scenarios and details on documentation, coding guidelines, and potential interventions

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IHI Releases “How-to-Guide” for Home Health/Community Settings

This week the Institute for HealthCare Improvement (IHI) posted on their website, The How-to Guide: Improving Transitions from the Hospital to Post-Acute Care Settings to Reduce Avoidable Re-hospitalizations. This How-to-Guide is designed to support hospital-based teams and their community partners to co-design and reliably implement improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition to home or to the next community care setting. The Home Care Alliance is acknowledged as a contributor and editor of this document.

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Avoid Denied Claims-Follow Medicare’s Provider Enrollment Guidelines.

As reported in the HCA’s Update last week, CMS published in the Federal Register  “Medicare and Medicaid Programs: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreement.”

This final rule finalizes several provisions of the Affordable Care Act implemented in the May 5, 2010 interim final rule with comment period. It requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. In addition, it requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare.

To receive payment for home health services, any Medicare-enrolled Home Health Agency must file claims containing the name and National Provider Identifier (NPI) of the physician who ordered the service.

The ordering physician must be enrolled in PECOS. The NPI used must be for an individual physician (cannot be a group or organizational NPI) and the individual physician must be of a specialist type that is eligible to order; Doctors of Medicine or Osteopathy, Doctors of Podiatric Medicine

Failure to meet the requirements mentioned above will result in denied claims once the automatic edits are activated.  The Medicare Learning Network’s “Medicare Enrollment Guidelines for Ordering/Referring Providers” is an excellent fact sheet if you need more information

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Challenged with Teaching New Staff OASIS

When home care agencies hire clinicians with little to no home care experience it certainly is a challenge to orient new staff to all the home care policies, procedures, regulations and OASIS. A tremendous amount of time and resources are needed for the opportunity to education the clinician. CMS created four training videos that are related to OASIS-C and process measure items. These videos may be a good resource for home care orientation.

They are available on YouTube as follows:

The Process Based Quality Improvement (PBQI) process.

Accurately Responding to Process Items: Intervention Synopsis (M2400)

Accurately Responding to Process Items: Plan of Care Synopsis (M2250)

Accurately Responding to Process Items: Fall Risk Assessment (M1910)

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FYI: “Home Health Prospective Payment System” Fact Sheet Revised

The Medicare Learning Network has recently released the revised Home Health Prospective Payment System” fact sheet and is now available in downloadable format. It includes the following information: background, consolidated billing requirements, criteria that must be met to qualify for home health services, coverage of home health services, elements of the HH PPS, updates to the HH PPS, and healthcare quality. This can be used as a handy tool for new employees to home health care!

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Training for the CDC’s World Health Organization Growth Chart is Now Available

The Centers for Disease Control and Prevention (CDC) has created an online training course for health care providers and others who measure and assess growth of infants and young children. The course is using the World Health Organization (WHO) Growth Charts to Assess Growth with Children less than 2 Years of Age in the U.S.  The recommendation for children less than 2 years of age is based in part on the recognition that breastfeeding is the recommended standard for infant feeding.  In the WHO charts, the growth of the healthy breastfed infant is intended to be the standard against which the growth of all other infants is compared. This online training takes 45 minutes to complete; there are self-assessment questions in each section.

The World Health Organization released a new international growth standard for infants and young children ages birth to 5 years of age. The standard shows how infants and children should grow.  The CDC now recommends that health care providers use:

  •    The WHO growth standard charts  for children aged birth to less than two years regardless of type of feeding, to monitor growth in the U.S.
  •    The CDC growth reference charts  for children aged two to twenty years to monitor growth in the U.S.

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